Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell
Introduction
Over the last three decades, differing views have been expressed about circumcision in the neonatal period and its preventive effect on urinary tract infection (UTI), but there is no general agreement as to its role. A systematic review revealed that circumcision is beneficial only in high-risk boys [1]. The American Academy of Pediatrics revised its policy in 1999, and suggested that there is medical benefit from newborn circumcision but did not recommend it to be used routinely [2]. Another study suggested that, because of multiple confounding factors, circumcision had no demonstrable preventive effect on UTI [3].
We designed this prospective study to determine the true value of neonatal circumcision in preventing UTI, by excluding the possible confounding factors identified in previous studies [4], [5], [6]. We recorded complications related to circumcision by Plastibell using a large control group with long-term follow up.
Section snippets
Materials and methods
Since the majority of parents were inclined to have their child circumcised during the first month of life, it was difficult to procure a large control group. The enrollment of circumcised cases was completed by achieving the target of 3000 neonates, while the difficult task of recruiting and managing 1000 non-circumcised cases (given the high conversion rate to circumcision) was more protracted. Thus, our study was conducted prospectively in a non-randomized quasi-experimental format.
Between
Results
Positive urine culture (colony count > 105) was observed in 16 circumcised infants and confirmed in none of them with suprapubic aspiration urine samples. Renal ultrasound and voiding cystourethrogram in these infants revealed no evidence of anomaly. There were a few cases (15) of suspicious culture (colony count > 103 and <105) in the circumcised group that examination of a second urine culture revealed as having no bacterial growth.
There were 110 positive or equivocal (colony count > 103 and <105)
Discussion
The rate of UTI in febrile children under 1 year has been reported as 1.84–14.14% [8], [9]. The reliability and accuracy of urine culture for confirmation of UTI in febrile circumcised and non-circumcised patients is affected by the method of urine collection (clean catch, bag or suprapubic aspiration), collection rate, poor hygienic practice [10], recent consumption of antibiotic for other reason [7], and history of prematurity and low birth weight [5].
The positive predictive value when using
Conflict of interest/funding
None.
References (26)
Effect of confounding in the association between circumcision status and urinary tract infection
J Infect
(2005)Complications of circumcision
Urol Clin North Am
(1983)- et al.
Plastibell circumcision: a minor surgical procedure of major importance
J Pediatr Urol
(2010) - et al.
Severe complications of circumcision: an analysis of 48 cases
J Pediatr Urol
(2007) - et al.
Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies
Arch Dis Child
(2005) Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision
Pediatrics
(1999)- et al.
Urinary tract infection in premature infants: the role of imaging studies and prophylactic therapy
J Perinatol
(1997) - et al.
Urinary tract infection in high-risk newborn infants
Pediatrics
(1978) Influence of maternal renal infection on the foetus and infant
Arch Dis Child
(1967)- et al.
Medical histories of children with acute pyelonephritis compared with controls
Pediatr Infect Dis J
(1989)